scholarly journals Tricks and pitfalls in the surgical treatment of malignant bone tumours of the forearm in children and adolescents

2021 ◽  
Vol 15 (4) ◽  
pp. 366-371 ◽  
Author(s):  
Bulent Erol ◽  
Omer Sofulu
Keyword(s):  
Surgical Management ◽  
Multidisciplinary Approach ◽  
Functional Results ◽  
Bone Tumours ◽  
Soft Tissue Reconstruction ◽  
Unique Region ◽  
Reconstruction Methods ◽  
Malignant Bone Tumours ◽  
Tissue Reconstruction ◽  
Bone Sarcomas

Malignant bone tumours around the forearm are rare. Nowadays, oncological and surgical management of bone sarcomas of this region has improved significantly. Although the anatomical features are complex, limb-sparing surgery is possible with wide surgical resection. Biological reconstruction methods are promising in this anatomically unique region. In addition, meticulous soft-tissue reconstruction yields good functional results in the hand and wrist. This study reviews malignant bone tumours of the forearm and their oncological and surgical management. Malignant bone tumours should be treated with a multidisciplinary approach based on chemotherapy, radiotherapy and limb salvage procedures.

Multidisciplinary Approach to Soft-Tissue Reconstruction of the Diabetic Charcot Foot

2015 ◽  
Vol 135 (2) ◽  
pp. 611-616 ◽  
Author(s):  
Jeremy C. Sinkin ◽  
Megan Reilly ◽  
Alexis Cralley ◽  
Paul J. Kim ◽  
John S. Steinberg ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Multidisciplinary Approach ◽  
Soft Tissue Reconstruction ◽  
Charcot Foot ◽  
Tissue Reconstruction

scholarly journals Current review of surgical management options for extremity bone sarcomas

2019 ◽  
Vol 4 (5) ◽  
pp. 174-182 ◽  
Author(s):  
Catalin Cirstoiu ◽  
Bogdan Cretu ◽  
Bogdan Serban ◽  
Zsombor Panti ◽  
Mihai Nica
Keyword(s):  
Surgical Management ◽  
Survival Rates ◽  
Bone Sarcoma ◽  
Functional Results ◽  
Bone Transport ◽  
Endoprosthetic Reconstruction ◽  
Management Options ◽  
Surgical Options ◽  
Bone Sarcomas ◽  
Excision Margins

Modern surgical management of extremity bone sarcomas is governed by limb-sparing surgery combined with adjuvant and neoadjuvant chemotherapy. All the resection and reconstruction techniques have to achieve oncologic excision margins, with survival rates and functional results superior to amputation. The main reconstruction techniques of bone defects resulted after resection are: modular endoprosthetic reconstruction; bone graft reconstruction; bone transport; resection arthrodesis; and rotationplasty. Oncologic resection and modular endoprosthetic reconstruction are the generally approved surgical options adopted for the majority of cases in major specialized bone sarcoma centres. Good basic principles, efficient multidisciplinary approach and sustained research in the field can provide a better future for the challenge posed by extremity bone sarcoma treatment. Cite this article: EFORT Open Rev 2019;4:174-182. DOI: 10.1302/2058-5241.4.180048

Carpal Instability Non-Dissociative

1994 ◽  
Vol 19 (6) ◽  
pp. 763-773 ◽  
Author(s):  
T. W. WRIGHT ◽  
J. H. DOBYNS ◽  
R. L. LINSCHEID ◽  
W. MACKSOUD ◽  
J. SIEGERT
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Surgical Management ◽  
Clinical Evidence ◽  
Wrist Pain ◽  
Carpal Instability ◽  
Soft Tissue Reconstruction ◽  
Results Of Treatment ◽  
Significant Difference ◽  
Tissue Reconstruction

A retrospective study of 45 patients with symptoms of wrist pain and weakness with clinical evidence of instability is presented. These patients had normal intrinsic interosseous ligaments demonstrated arthrographically or surgically. They were followed for a minimum of 18 months and an average of 5.8 years. All patients demonstrated instability of the proximal carpal row which is referred to as carpal instability non-dissociative (CIND). Seven patients were treated non-operatively and 38 were treated operatively. Surgical management consisted of soft tissue reconstruction directed at the area of instability in 34 cases, joint levelling osteotomy in six, three of whom also had soft tissue reconstructions, and mid-carpal fusion in one. The overall good and excellent results were a disappointing 56% and there was no significant difference between the non-surgical and surgical groups. The best results were found in the ulna-minus CIND patients who underwent a joint levelling osteotomy, with 83% good and excellent results. CIND is associatedwith extrinsic ligamentous laxity; however, significant difficulty exists in locating the precise areas of maximum pathology. This accounts for the unpredictable results of treatment. As our understanding of the pathomechanics of CIND improves, the treatment will become more specific and the results should improve.

scholarly journals Comparison between Constrained and Semiconstrained Knee Allograft-Prosthesis Composite Reconstructions

Sarcoma ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
German L. Farfalli ◽  
Luis A. Aponte-Tinao ◽  
Miguel A. Ayerza ◽  
D. Luis Muscolo ◽  
Patrick J. Boland ◽  
...  
Keyword(s):  
Survival Rate ◽  
Aseptic Loosening ◽  
Knee Prosthesis ◽  
Functional Results ◽  
Soft Tissue Reconstruction ◽  
Functional Scores ◽  
Rotating Hinge ◽  
Tissue Reconstruction ◽  
Group 2 ◽  
Group 1

Allograft-prosthesis composite (APC) can restore capsular and ligamentous tissues of the knee sacrificed in a tumor extirpation. We asked if performing APC would restore knee stability and allow the use of nonconstrained arthroplasty while preventing aseptic loosening. We retrospectively compared 50 knee APCs performed with non-constrained revision knee prosthesis (Group 1) with 36 matched APCs performed with a constrained prosthesis (Group 2). In Group 1, the survival rate was 69% at five and 62% at ten years. Sixteen reconstructions were removed due to complications: eight deep infections, three fractures, two instabilities, one aseptic loosening, one local recurrence, and one nonunion. In Group 2, the survival rate was 80% at five and 53% at ten years. Nine reconstructions were removed: 3 due to deep infections, 3 to fractures, and 3 to aseptic loosening. In both groups, we observed more allograft fractures when the prosthetic stem does not bypass the host-donor osteotomy (). Both groups had mainly good or excellent MSTS functional results. Survival rate and functional scores and aseptic loosening were similar in both groups. A rotating-hinge APC is recommended when host-donor soft tissue reconstruction fails to restore knee instability. The use of a short prosthetic stem has a statistical relationship with APC fractures.

Combined joint fusion for index and middle carpometacarpal instability in elite boxers

2013 ◽  
Vol 39 (3) ◽  
pp. 242-248 ◽  
Author(s):  
N. Nazarian ◽  
R. S. Page ◽  
G. A. Hoy ◽  
M. J. Hayton ◽  
M. Loosemore
Keyword(s):  
Functional Results ◽  
Middle Finger ◽  
Acute Injury ◽  
Consecutive Series ◽  
Soft Tissue Reconstruction ◽  
Carpometacarpal Joints ◽  
Tissue Reconstruction ◽  
The Uk ◽  
Surgical Treatments ◽  
Simple Reduction

Isolated instability of the index and middle finger carpometacarpal joints is uncommon. An unpublished injury pattern in a consecutive series of 13 elite boxers is described, with mid-term radiological and functional results of two novel surgical treatments. All the boxers (from Australia and the UK) were unable to compete owing to pain and weakness. Four boxers were managed initially by open reduction and temporary K-wire fixation. Nine boxers underwent primary carpometacarpal arthrodesis. All were able to return to their previous level of competition. One boxer who had undergone a soft tissue reconstruction competed at international level but required an arthrodesis because of recurrent symptoms. In elite boxers, simple reduction and wiring may be appropriate for an acute injury causing index or middle finger carpometacarpal joint instability, however, arthrodesis is the treatment of choice when instability and degenerative changes are present.

scholarly journals Functional Reconstruction of Sarcoma Defects Utilising Innervated Free Flaps

Sarcoma ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Damien Grinsell ◽  
Claudia Di Bella ◽  
Peter F. M. Choong
Keyword(s):  
Soft Tissue ◽  
Abdominal Wall ◽  
Upper Limb ◽  
Lower Limb ◽  
Free Flaps ◽  
Functional Results ◽  
Wide Resection ◽  
Soft Tissue Reconstruction ◽  
Functional Scores ◽  
Tissue Reconstruction

Soft-tissue reconstruction following preoperative radiotherapy and wide resection of soft tissue sarcoma remains a challenge. Pedicled and free tissue transfers are an essential part of limb sparing surgery. We report 22 cases of sarcoma treated with radiotherapy and wide excision followed by one-stage innervated free or pedicled musculocutaneous flap transfers. The resection involved the upper limb in 3 cases, the lower limb in 17, and the abdominal wall in 2. The flaps used for the reconstruction were mainly latissimus dorsi and gracilis. The range of motion was restored fully in 14 patients. The muscle strength of the compartment reconstructed was of grades 4 and 5 in all patients except one. The overall function was excellent in all the cases with functional scores of 71.2% in the upper limb and 84% in the lower limb. The only 2 major complications were flap necrosis, both revised with another flap, one of which was innervated with restoration of function. Innervated flaps are valuable alternatives for reconstruction after sarcoma resection in the extremity and in the abdominal wall. The excellent functional results are encouraging, and we believe that innervated muscle reconstruction should be encouraged in the treatment of sarcoma after radiotherapy and wide resection.

scholarly journals Non-surgical management of a tibiofemoral knee dislocation in a patient with sarcoidosis

2019 ◽  
Vol 12 (11) ◽  
pp. e229605
Author(s):  
Daniel Flowers ◽  
Margaret Olmedo
Keyword(s):  
Surgical Treatment ◽  
Surgical Management ◽  
Functional Outcomes ◽  
Treatment Guidelines ◽  
Knee Dislocation ◽  
Soft Tissue Reconstruction ◽  
Positive Functional ◽  
Tissue Reconstruction ◽  
Non Surgical Treatment ◽  
Complex Injuries

This case presents a patient who sustained a knee dislocation, and who due to her diagnosis of sarcoidosis, other comorbidities, and prolonged use of corticosteroids, external fixation and physical therapy were implemented versus soft tissue reconstruction/repair. Research indicates worse functional outcomes with non-surgical treatment, and guidelines on optimising outcomes in this population are lacking. Integrated care of the patient—even when complex injuries and comorbid medical conditions are present—can lead to positive functional recovery, despite previous data. Evidence from related injuries can be successfully adapted in non-surgical management of these injuries, providing general treatment guidelines.

scholarly journals Efficacy of Extracorporeal Irradiation in Primary Malignant Bone Tumours: A Tertiary Cancer Centre Experience

2019 ◽  
Vol 4 (2) ◽  
pp. 53-57
Author(s):  
Gunaseelan K ◽  
Dilip Kumar Patro ◽  
Arun Lal ◽  
Kannan P ◽  
Biswajit D ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Local Control ◽  
Soft Tissues ◽  
Functional Results ◽  
Bone Tumours ◽  
En Bloc ◽  
Free Survival ◽  
Malignant Bone Tumours ◽  
Bone Segment ◽  
Extracorporeal Irradiation

Background: Limb-sparing approaches involving a combination of surgery, chemotherapy, and radiotherapy are preferred in primary malignant bone tumours whenever possible. The limb function can be maintained by performing reconstruction either using a prosthesis or bone graft. Extracorporeal irradiation is a novel and exciting technique in which the restoration is done using the patient’s own tumour bone. In this article, we present the local control, complications, and functional outcome of 49 cases of primary malignant bone tumours treated using the technique of extracorporeal irradiation. Materials and methods: 49 patients with primary malignant bone tumours were treated with extracorporeal irradiation between the year 2007 to 2015.En-bloc resection of the tumour and the involved bone along with soft tissues was performed about four weeks after the completion of three to four cycles of neoadjuvant chemotherapy. The bone segment was irradiated with 6MV linear accelerator to a dose of 50Gy. After extracorporeal irradiation, the bone was re-implanted using fixation devices. Local control, relapse-free survival, complications and functional outcome were studied. Results: Out of 49 patients, there were 33 males and 16 females. The median age was 19 years. Femur and tibia were the most common tumour locations with osteosarcoma being the most common histology (74%). The local control rate was 94%. The 8 year local recurrence-free survival and distant metastasis-free survival were 89% and 84% respectively. The overall complication rate was 20%. Infection was the most frequent complication, observed in 46% of the patients who developed complications. Out of 49 patients, 40 had reported a good range of movements. Conclusion: Extracorporeal irradiation and re-implantation is a convenient alternative to prosthesis from a health economics point of view, provided severe complications are managed and avoided so that functional results can be achieved.  

scholarly journals Osteomyelitis of the Pelvic Bones: A Multidisciplinary Approach to Treatment

2017 ◽  
Vol 2 (4) ◽  
pp. 184-193 ◽  
Author(s):  
Maria Dudareva ◽  
Jamie Ferguson ◽  
Nicholas Riley ◽  
David Stubbs ◽  
Bridget Atkins ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Case Series ◽  
Recurrent Infection ◽  
Surgical Excision ◽  
Soft Tissue Reconstruction ◽  
Tertiary Referral Centre ◽  
Type Iv ◽  
Tissue Reconstruction ◽  
Wound Healing Problems

Abstract. Background and Purpose: A case series review of chronic pelvic osteomyelitis treated with combined medical and surgical treatment by a multidisciplinary team.Methods: All patients treated with surgical excision of pelvic osteomyelitis at our tertiary referral centre between 2002 and 2014 were included. All received combined care from a clinical microbiologist, an orthopaedic surgeon and a plastic surgeon. The rate of recurrent infection, wound healing problems and post-operative mortality was determined in all. Treatment failure was defined as reoperation involving further bone debridement, a requirement for the use of long-term suppressive antibiotics or sinus recurrence.Results: Sixty-one adults (mean age 50.2 years, range 16.8-80.6) underwent surgery. According to the Cierny-Mader classification of osteomyelitis there were 19 type II, 35 type III and 7 type IV cases. The ischium was the most common site of infection. Osteomyelitis was usually the result of contiguous focus infection associated with decubitus ulcers, predominantly in patients with spinal or cerebral disorders. Most patients with positive microbiology had polymicrobial infection (52.5%). Thirty patients required soft tissue reconstruction with muscle or myocutaneous flaps.Twelve deaths occurred a mean of 2.8 years following surgery (range 7 days-7.4 years). Excluding these deaths the mean follow-up was 4.6 years (range 1.5-12.2 years). Recurrent infection occurred in seven (11.5%) a mean of 1.5 years post-operatively (92 days - 5.3 years). After further treatment 58 cases (95.1%) were infection free at final follow-up.Interpretation: Patients in this series have many comorbidities and risk factors for poor surgical outcome. Nevertheless, the multidisciplinary approach allows successful treatment in the majority of cases.

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